The maxillary dental casts can be reliably superimposed on the medial points of the third palatal rugae and the palatal vault as reference landmarks.

Despite inherent errors, cephalometric superimpositions are currently the most widely used means for assessing sagittal and vertical tooth movements. The purpose of this study was to compare three-dimensional (3D) digital model superimposition with cephalometric superimposition. The material was collected from initial and final maxillary casts and lateral cephalometric radiographs of 30 patients (6 males, 24 females, mean age 17.7 years) who underwent orthodontic treatment with extraction of permanent teeth. Each pair of cephalograms was traced and superimposed according to Ricketts' four-step method. 3D scanning of the maxillary dental casts was performed using INUS dental scanning solution(R), which consists of a 3D scanner, an autoscan system, and 3D reverse modelling software. The 3D superimposition was carried out using the surface-to-surface matching (best-fit method) function of the autoscan system. The antero-posterior movement of the maxillary first molar and central incisor was evaluated cephalometrically and on 3D digital models. To determine whether any difference existed between the two measuring techniques, paired t-tests and correlation analysis were undertaken. The results revealed no statistical differences between the mean incisor and molar movements as assessed cephalometrically or by 3D model superimposition. These findings suggest that the 3D digital orthodontic model superimposition technique used in this study is clinically as reliable as cephalometric superimposition for assessing orthodontic tooth movements.

The results suggest that the more Class III and the more hyperdivergent type, the higher resting TMA and the lesser increase of clenching MMA than expressed by other groups. Significant differences existed in TMA and MMA according to sagittal and vertical facial skeletal types.

Objective: To (1) evaluate the stability of palatal rugae as landmarks for superimposition of dental casts and (2) establish a three-dimensional superimposition method of maxillary dental casts for analyzing orthodontic tooth movement. Materials and Methods: The sample consisted of dental casts obtained from 10 patients treated with extraction of bilateral maxillary first premolars and placement of three palatal miniscrews as anchorage for retraction of the anterior teeth. Dental casts were measured by means of laser surface scanning system, and three-dimensional images were reconstructed. Serial dental casts were superimposed on the three miniscrews as registration landmarks (miniscrew-superimposition method), and the displacement of each palatal ruga point during the closure of extraction spaces was measured. Displacement of the central incisors was measured by the miniscrew-superimposition method and the proposed superimposition technique (ruga-palate-superimposition method). Correlation analysis and paired t-tests were performed to determine whether a significant difference existed between the measurements of the two superimposition methods. Results: The medial points of the third palatal rugae and the shape of the palatal vault were stable throughout the treatment. The displacement of the central incisors measured using the ruga-palate-superimposition method showed no significant difference with that measured using the miniscrew-superimposition method. Conclusion: The maxillary dental casts can be reliably superimposed on the medial points of the third palatal rugae and the palatal vault as reference landmarks. (Angle Orthod. 2009;79: 447-453.)

BackgroundA 9-year-old male showed severe defects in midface structures, which resulted in maxillary hypoplasia, ocular hypertelorism, relative mandibular prognathism, and syndactyly. He had been diagnosed as having Apert syndrome and received a surgery of frontal calvaria distraction osteotomy to treat the steep forehead at 6 months old, and a surgery of digital separation to treat severe syndactyly of both hands at 6 years old. Nevertheless, he still showed a turribrachycephalic cranial profile with proptosis, a horizontal groove above supraorbital ridge, and a short nose with bulbous tip.MethodsFundamental aberrant growth may be associated with the cranial base structure in radiological observation.ResultsThe Apert syndrome patient had a shorter and thinner nasal septum in panthomogram, PA view, and Waters’ view; shorter zygomatico-maxillary width (83.5 mm) in Waters’ view; shorter length between the sella and nasion (63.7 mm) on cephalogram; and bigger zygomatic axis angle of the cranial base (118.2°) in basal cranial view than a normal 9-year-old male (94.8 mm, 72.5 mm, 98.1°, respectively). On the other hand, the Apert syndrome patient showed interdigitating calcification of coronal suture similar to that of a normal 30-year-old male in a skull PA view.ConclusionTaken together, the Apert syndrome patient, 9 years old, showed retarded growth of the anterior cranial base affecting severe midface hypoplasia, which resulted in a hypoplastic nasal septum axis, retruded zygomatic axes, and retarded growth of the maxilla and palate even after frontal calvaria distraction osteotomy 8 years ago. Therefore, it was suggested that the severe midface hypoplasia and dysostotic facial profile of the present Apert syndrome case are closely relevant to the aberrant growth of the anterior cranial base supporting the whole oro-facial and forebrain development.